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Müller M, Hautz W, Louma Y, Knapp J, Schnüriger B, Simmen HP, Pietsch U, Jakob DA. Accuracy between prehospital and hospital diagnosis in helicopter emergency medical services and its consequences for trauma care. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02505-y. [PMID: 38563962 DOI: 10.1007/s00068-024-02505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE For optimal prehospital trauma care, it is essential to adequately recognize potential life-threatening injuries in order to correctly triage patients and to initiate life-saving measures. The aim of the present study was to determine the accuracy of prehospital diagnoses suspected by helicopter emergency medical services (HEMS). METHODS This retrospective multicenter study included patients from the Swiss Trauma Registry with ISS ≥ 16 or AIS head ≥ 3 transported by Switzerland's largest HEMS and subsequently admitted to one of twelve Swiss trauma centers from 01/2020 to 12/2020. The primary outcome was the comparison of injuries suspected prehospital with the final diagnoses obtained at the hospital using the abbreviated injury scale (AIS) per body region. As secondary outcomes, prehospital interventions were compared to corresponding relevant diagnoses. RESULTS Relevant head trauma was the most commonly injured body region and was identified in 96.3% (95% CI: 92.1%; 98.6%) of the cases prehospital. Relevant injuries to the chest, abdomen, and pelvis were also common but less often identified prehospital [62.7% (95% CI: 54.2%; 70.6%), 45.5% (95% CI: 30.4%; 61.2%), and 61.5% (95% CI: 44.6%; 76.6%)]. Overall, 7 of 95 (7.4%) patients with pneumothorax received a chest decompression and in 22 of 39 (56.4%) patients with an instable pelvic fracture a pelvic binder was applied prehospital. CONCLUSION Approximately half of severe chest, abdominal, and pelvic diagnoses made in hospital went undetected in the challenging prehospital environment. This underlines the difficult circumstances faced by the rescue teams. Potentially life-saving interventions such as prehospital chest decompression and increased use of a pelvic binder were identified as potential improvements to prehospital care.
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Affiliation(s)
- Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Wolf Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Yves Louma
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Beat Schnüriger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Peter Simmen
- Department of Traumatology, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Urs Pietsch
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Division of Perioperative Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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Häske D, Lefering R, Stock JP, Kreinest M. Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures. Eur J Trauma Emerg Surg 2020; 48:1975-1983. [PMID: 33025171 PMCID: PMC9192373 DOI: 10.1007/s00068-020-01515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 10/30/2022]
Abstract
PURPOSE This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization. METHODS Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled. RESULTS The mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2-3 on the AIS, and 4.1% scored 4-6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4-6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4-6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3-6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3-6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI. CONCLUSIONS In addition to the clinical symptoms of pain, we identify '4S' [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.
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Affiliation(s)
- David Häske
- German Red Cross, Emergency Medical Service, Obere Wässere 1, 72764, Reutlingen, Germany. .,Center for Public Health and Health Services Research, University Hospital Tübingen, Tübingen, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Jan-Philipp Stock
- Department of Anesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Klinikum am Steinenberg, Reutlingen, Germany
| | - Michael Kreinest
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
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Haugland H, Uleberg O, Klepstad P, Krüger A, Rehn M. Quality measurement in physician-staffed emergency medical services: a systematic literature review. Int J Qual Health Care 2019; 31:2-10. [PMID: 29767795 PMCID: PMC6387994 DOI: 10.1093/intqhc/mzy106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/14/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Quality measurement of physician-staffed emergency medical services (P-EMS) is necessary to improve service quality. Knowledge and consensus on this topic are scarce, making quality measurement of P-EMS a high-priority research area. The aim of this review was to identify, describe and evaluate studies of quality measurement in P-EMS. DATA SOURCES The databases of MEDLINE and Embase were searched initially, followed by a search for included article citations in Scopus. STUDY SELECTION The study eligibility criteria were: (1) articles describing the use of one quality indicator (QI) or more in P-EMS, (2) original manuscripts, (3) articles published from 1 January 1968 until 5 October 2016. The literature search identified 4699 records. 4543 were excluded after reviewing title and abstract. An additional 129 were excluded based on a full-text review. The remaining 27 papers were included in the analysis. Methodological quality was assessed using an adapted critical appraisal tool. DATA EXTRACTION The description of used QIs and methods of quality measurement was extracted. Variables describing the involved P-EMSs were extracted as well. RESULTS OF DATA SYNTHESIS In the included papers, a common understanding of which QIs to use in P-EMS did not exist. Fifteen papers used only a single QI. The most widely used QIs were 'Adherence to medical protocols', 'Provision of advanced interventions', 'Response time' and 'Adverse events'. CONCLUSION The review demonstrated a lack of shared understanding of which QIs to use in P-EMS. Moreover, papers using only one QI dominated the literature, thus increasing the risk of a narrow perspective in quality measurement. Future quality measurement in P-EMS should rely on a set of consensus-based QIs, ensuring a comprehensive approach to quality measurement.
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Affiliation(s)
- Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesia, Oslo University Hospital, Oslo, Norway
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Macke C, Sarakintsis M, Winkelmann M, Mommsen P, Omar M, Schröter C, Krettek C, Zeckey C. Influence of Entrapment on Prehospital Management and the Hospital Course in Polytrauma Patients: A Retrospective Analysis in Air Rescue. J Emerg Med 2018; 54:827-834. [PMID: 29680410 DOI: 10.1016/j.jemermed.2018.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/12/2018] [Accepted: 02/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Entrapment is a challenging and crucial factor in the prehospital setting. Few studies have addressed whether entrapment has an influence on on-scene treatment or on the following hospital course. OBJECTIVES Here we aimed to investigate the influence of entrapment on prehospital management and on the hospital course of polytrauma patients. METHODS We performed a retrospective analysis of consecutive patients with an Injury Severity Score ≥16 and aged 16-65 years that were admitted between 2005 and 2013 to a Level I trauma center. Two groups were built: entrapped (E) and nonentrapped patients (nE). These groups were evaluated for multiple prehospital and clinical parameters, including on-scene time, prehospital interventions, and posttraumatic complications. RESULTS There were 310 patients (n = 194 no entrapment [Group nE], n = 116 with entrapment [Group E]) enrolled. The on-scene time was significantly longer in Group E than Group nE. Moreover, this group received a significantly higher volume of colloidal solution. Regarding the Injury Severity Score and Abbreviated Injury Scale (AIS), there were no significant differences between the groups, except for the AISextremities, which was significantly increased in Group E. The overall hospital stay and the initial theater time were significantly longer in Group E than Group nE. No significant differences were present for the occurrence of systemic inflammatory response syndrome, multiple organ dysfunction syndrome, and acute respiratory distress syndrome, nor for Acute Physiology and Chronic Health Evaluation II and estimated and final mortality. CONCLUSION In polytraumatized patients, entrapment has a minor influence on the outcome and treatment in the prehospital and hospital setting when using physician-based air rescue. However, entrapped patients are prone to sustain more severe trauma to the extremities.
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Affiliation(s)
- Christian Macke
- Trauma Department, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Marika Sarakintsis
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Marcel Winkelmann
- Trauma Department, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Mommsen
- Trauma Department, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | | | - Christian Krettek
- Trauma Department, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Zeckey
- Trauma Department, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany; Department of General, Trauma, and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Munich, Germany
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Liao S, Schneider NRE, Hüttlin P, Grützner PA, Weilbacher F, Matschke S, Popp E, Kreinest M. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction-A study in two new cadaveric trauma models. PLoS One 2018; 13:e0195215. [PMID: 29624623 PMCID: PMC5889057 DOI: 10.1371/journal.pone.0195215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022] Open
Abstract
Background Unstable conditions of the craniocervical junction such as atlanto-occipital dislocation (AOD) or atlanto-axial instability (AAI) are severe injuries with a high risk of tetraplegia or death. Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in trauma patients. If the application of a cervical collar to a patient with an unstable craniocervical condition may cause segmental motion and secondary injury to the spinal cord is unknown. The aim of the current study is (i) to analyze compression on the dural sac and (ii) to determine relative motion of the cervical spine during the procedure of applying a cervical collar in case of ligamentous unstable craniocervical junction. Methods and findings Ligamentous AOD as well as AOD combined with ligamentous AAI was simulated in two newly developed cadaveric trauma models. Compression of the dural sac and segmental angulation in the upper cervical spine were measured on video fluoroscopy after myelography during the application of a cervical collar. Furthermore, overall three-dimensional motion of the cervical spine was measured by a motion tracking system. In six cadavers each, the two new trauma models on AOD and AOD combined with AAI could be implemented. Mean dural sac compression was significantly increased to -1.1 mm (-1.3 to -0.7 mm) in case of AOD and -1.2 mm (-1.6 to -0.6 mm) in the combined model of AOD and AAI. Furthermore, there is a significant increased angulation at the C0/C1 level in the AOD model. Immense three-dimensional movement up to 22.9° of cervical spine flexion was documented during the procedure. Conclusion The current study pointed out that applying a cervical collar in general will cause immense three-dimensional movement. In case of unstable craniocervical junction, this leads to a dural sac compression and thus to possible damage to the spinal cord.
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Affiliation(s)
- Shiyao Liao
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Niko R. E. Schneider
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Petra Hüttlin
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Paul A. Grützner
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Frank Weilbacher
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Stefan Matschke
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Erik Popp
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Michael Kreinest
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
- * E-mail:
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Bernhard M, Helm M, Lechleuthner A. Erstversorgung vor Ort oder schnellstmöglicher Transportbeginn? Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0360-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Koppenberg J, Button D, Albrecht R. [Not Available]. PRAXIS 2017; 106:825-828. [PMID: 28745113 DOI: 10.1024/1661-8157/a002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Zusammenfassung: Schwere Unfälle zählen weiterhin zu den häufigsten Todesursachen bei jungen Erwachsenen. Die Notfallmedizin hat im Bereich der Traumaversorgung in den vergangenen Jahren grosse Fortschritte erzielen können. In diesem Artikel werden die strukturelle Entwicklung der Notfallmedizin in der Schweiz und die medizinischen Behandlungsstrategien bei Schwerstverletzten dargestellt.
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Affiliation(s)
- Joachim Koppenberg
- 1 Abteilung für Anästhesiologie, Schmerztherapie und Rettungsmedizin, Ospidal - Gesundheitszentrum Unterengadin, Scuol
- 3 Schweizerische Rettungsflugwacht (Rega), Zürich-Flughafen
| | - Daniel Button
- 2 Institut für Anästhesiologie, Kantonsspital Winterthur
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An annual analysis of clinical diagnosis versus autopsy findings in fatal motor vehicle accident in legal medicine organization of Kerman province, Iran. J Forensic Leg Med 2015; 34:164-7. [DOI: 10.1016/j.jflm.2015.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 03/15/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022]
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